TB Knee

Jithin.B.K

The disease may begin as

Osseous tuberculosis
Tibial condyle Femoral condyle Patella (rare)

Synovial

tuberculosis

In the early stages of the disease

Disease

is confined to the synovium. No significant damage to the joint.

In the late stages of the disease

Articular cartilage and bone are destroyed. Synovial hypertrophy. Synovial effusion. Pus formation. Cartilage gets detached leaving the bone exposed.

Late stages (Contd)

Associated destruction of ligaments. Results in typical Triple displacement of Tibia.

(Tibial flexion, posterior subluxation, and external rotation).

Pus may burst out of capsule to present as a cold abscess, and subsequently a sinus.

Clinical Features
Age group 10-25 years. Pain and swelling in the knee. Gradual onset w/o any history of trauma. Subsequently, pain increases and knee takes an attitude of flexion. Patient starts limping. Severe stiffness to the knee.

On examination
Swollen joint. Muscular atrophy. Cold abscess. Discharging or healed sinus. Limited movements. Deformity of joint.

Mild flexion deformity in early stages. Triple displacement deformity in late stages.

Investigations:

Radiological investigations
Soft tissue shadow corresponding to distended knee. Wider joint space. Diffuse osteoporosis. Juxta-articular lytic lesions. Joint surface erosion. Joint space diminished or lost. Triple subluxation with cavitatory bone lesions in advanced stages.

Other investigations
Blood examination: Lymphocytic leucocytosis, high ESR. Mantoux test. Serum ELISA to detect antimycobacterium antibodies. Synovial fluid aspiration. Aspiration of cold abscess and AFB examination of pus. Histopathological examination of granulation tissue obtained by biopsy or curettage.

Differential diagnosis
In early stages presenting with synovitis, exclude...
Subacute pyogenic infection Monoarticular rheumatoid arthritis Chronic traumatic synovitis Rheumatic arthritis Haemophilic arthritis

Treatment
Aim of treatment is to achieve a painless mobile joint. In late stages, some amount of pain and stiffness persists in spite of treatment. Modalities:

CONSERVATIVE TREATMENT OPERATIVE TREATMENT

Conservative treatment:
ATT General care Local care of knee
Knee rested by applying belowknee skin traction (or) aboveknee POP slab. Helps in healing process. Helps in associated muscle spasm that keeps knee deformed.

Operative Treatment:
Synovectomy:
In cases of purely synovial tuberculosis.

Joint debridement:
In cases where articular cartilage is preserved.

Arthrodesis:

Charnleys compression arthodesis A popular method. In advanced stages with triple subluxation and complete cartilage destruction.

the end